What does vaginal bleeding and pain mean for me?
- We are aware that this is a very worrying time and that you and your partner may feel both frightened and frustrated.
- Vaginal bleeding and/or cramping pain in the early stages of pregnancy are common and do not always mean that there is a problem. However, bleeding and/or pain can be a warning sign of a miscarriage or, less commonly, of other complications of early pregnancy.
- 1 in 10 women may experience some bleeding.
- Bleeding in pregnancy is often called a “threatened miscarriage”. It does not necessarily mean that you will go on to miscarry.
Why does pain and/or bleeding happen?
- Implantation bleed – occurs in the very early stages of pregnancy around the time of the first missed period. It happens when the fertilised egg implants in the womb.
- Cervical ectropian – harmless changes in the neck in the womb (cervix) can cause bleeding- particularly after sexual intercourse. This is not harmful to the baby.
- Infection- can also cause abnormal bleeding.
- Miscarriage occurs in 1 in 4 pregnancies before 12 weeks gestation.
- Ectopic Pregnancy- occurs in 1 in 90 pregnancies in the UK when a pregnancy starts to develop outside of the womb.
- Molar Pregnancy- an uncommon condition affecting 1 in 700 pregnancies where the placenta is abnormal, and the pregnancy does not develop properly. Sometimes a cause for the bleeding is not found.
What tests will be done?
In A&E:
- You will be asked about your symptoms, the date of your last period and your medical history.
- A urine test will be carried out in order to confirm the pregnancy
- A speculum and/ or vaginal examination may be done to look at the cervix to see where the bleeding is coming from.
- Blood tests are sometimes done to check your blood group and/or the level of your pregnancy hormone (βHCG)
Will I get a Scan?
- Ultrasound scans are carried out in the Early Pregnancy Assessment Unit (EPAU): A specialist clinic for people who have problems with pain or bleeding in early pregnancy.
- You may be given an appointment to come to EPAU which is based in the Women’s Health Clinic. In light of the COVID pandemic we are trying to streamline this service and prevent unnecessary scans and exposure for you and your baby.
- This appointment is unlikely to be on the same day as you are seen in A&E
- You may be offered a vaginal or abdominal scan or both. This depends on how many weeks pregnant you are- a transvaginal scan may be recommended as it gives a clearer image in very early pregnancy.
- Neither scan will increase your risk of miscarriage.
- Sometimes a repeat scan may be necessary 7-14 days later if the pregnancy is very early and baby is not seen.
What should I do if I have more pain or bleeding?
If you have heavy bleeding, severe pain in your abdomen, pain in your shoulder, dizziness or fainting, you should attend your nearest Emergency department immediately.
- It is not uncommon to have further bleeding. If this remains as it was when you were assessed then please continue to follow the advice you were given.
- You can rest at home or continue with your normal routine. Whatever you do will not make a difference to the outcome of the pregnancy so do what feels right for you.
- Unfortunately, if the pregnancy is miscarrying it is not possible to do anything to change this.
- We have found that of all the women with bleeding in early pregnancy half of them will continue to be pregnant.
What should I do now?
- Make an EPAC appointment at the ED reception desk
- Face to face scan appointment
- Telephone appointment
- Repeat urinary pregnancy test in one week
- If remains POSITIVE please contact EPAU for further advice.
- If NEGATIVE, no follow up is required and pregnancy loss has been confirmed. This is clearly a very upsetting time and there are some useful resources below and the leaflet you were given at your attendance.
- Repeat urinary pregnancy test in three weeks
- If remains POSITIVE please continue to take pregnancy vitamins, book with a midwife and await your dating scan.
- If NEGATIVE, no follow up is required and pregnancy loss has been confirmed. This is clearly a very upsetting time and there are some useful resources below and the leaflet you were given at your attendance.
If you would like any further help or advice then please contact EPAU on the number given. Please understand that due to the high volume of calls they are dealing with they may not be able to contact you back for 24-48hrs.
Contact
Further information:-
Association of Early Pregnancy Assessment Units: www.earlypregnancy.org.uk
Ectopic Pregnancy Trust Tel: 01895 238 025 www.ectopic.org.uk
Miscarriage Association Tel: 01924 200799 www.miscarriageassociation.org.uk
National Institute for Health and Care Excellence (NICE): Ectopic Pregnancy and Miscarriage: www.nice.org.uk/guidance/cg154/ifp/chapter/About-this-information
NHS 111 service: www.nhs.uk/NHSEngland/AboutNHSservices/Emergencyandurgentcareservices/Pages/NHS-111.aspx
Royal College of Obstetricians and Gynaecologists www.rcog.org.uk/globalassets/documents/patients/patient-information-leaflets/pregnancy/pi-bleeding-and-or-pain-in-early-pregnancy.pdf